Surgical Co Management

All of our doctors at Handel Vision Clinic are competent and experienced in medical optometry, including the treatment of dry eye, infections, glaucoma, and macular degeneration. However, certain conditions may require surgical treatment which requires a referral to an ophthalmologist. In these cases, our doctors will work closely with your surgeon to co-manage your condition.

Communication between our doctors and your surgeon is vital to providing you with thorough and appropriate treatment. This is why we have preferred surgeons we work with, to ensure our patients receive the very best possible experience and care. We understand how important it is to maintain healthy eyes, which is why we only work with the best!

Although we co-manage a wide variety of ocular diseases, below are the most common conditions that may require surgeon involvement:

Cataracts

Cataracts are by far our most frequently referred ocular condition. Cataracts are most commonly an age-related condition that occurs as the proteins inside the clear lens of the eye begin to break down, creating a cloudy effect similar to car headlights becoming foggy over time. (You can learn more about cataracts here.)

Early cataracts require no treatment other than a possible update in your glasses or contact lens prescription. More advanced cataracts cause blurry vision that does not improve with a new prescription. The only treatment for advanced cataracts is to have them surgically removed by an ophthalmologist.

Cataract surgery is an incredibly common outpatient procedure in which the opacified lens of the eye is replaced with an artificial, clear lens, helping to restore vision. There are many options when it comes to cataract surgery lens implants, ranging from standard to advanced multifocal designs. (You can follow this link to read more on what to expect from cataract surgery and about the different types of cataract implants.)

Months after cataract surgery, some patients may develop a posterior capsular opacification (PCO) which is a big phrase for saying scar tissue may form behind the new implant. This scar tissue causes blurred vision and symptoms that are very similar to cataracts. For this reason, PCO is sometimes mistakenly referred to as a “secondary cataract.” Rest assured, though, that once your cataracts have been removed, they will never return, and PCO is quite common and easily treated in the office by an ophthalmologist with a special laser called a YAG.

Diabetic Retinopathy

All diabetic patients need to be monitored closely for any development of retinopathy. (You can learn more about diabetic retinopathy here.) In many cases, mild forms of retinopathy can be treated with better control of blood sugar or a change in medication. Our doctors will communicate their findings with your endocrinologist to ensure proper co-management of your disease.

In more severe cases, it may be necessary to refer to an ophthalmologist for treatment to help stop bleeding in the retina and prevent permanent vision loss. These treatments may include medicated injections into the eye to stop proliferation (blood vessel growth), laser treatments to help reduce swelling and prevent blood vessel leakage, or a vitrectomy, a surgery in which the clear, jellylike substance inside of the eye (the vitreous) is removed and replaced with a clear, artificial fluid. This may be necessary in cases of dense vitreous hemorrhages.

Glaucoma

Glaucoma is an eye disease that causes damage to the optic nerve, resulting in vision loss. (You can learn more about glaucoma here.) Most cases of glaucoma can be effectively managed with medicated eye drops used once or more per day.

If these drops are not effective or if the patient is unable or unwilling to use them, surgical treatment may be necessary. The type of surgery required depends on the classification of glaucoma you have been diagnosed with. The two main types of glaucoma are primary open-angle glaucoma (POAG) and acute angle-closure glaucoma (or narrow-angle glaucoma).

POAG develops as the drainage canal of the eye slowly becomes clogged. This prevents the fluid in the eye from draining properly so it will begin to back up which increases the pressure inside of the eye. If surgical treatment is required, it may come in the form of laser treatment, surgery, or implantation of a drainage shunt. (You can learn more about each of these glaucoma treatments here.)

Narrow-angle glaucoma is an emergency that requires immediate treatment. In this situation, the drainage canals of the eye are suddenly blocked causing a sharp rise in intraocular pressure. A surgeon will perform what is called a laser peripheral iridotomy (LPI) which creates a small hole in the outer edge of your iris (the colored part of the eye) to widen the drainage pathway and lower the intraocular pressure. (You can learn more about LPI’s here.)

Macular Degeneration

Age-Related Macular Degeneration (AMD) is an ocular disease that affects the central part of the retina, called the macula. (You can learn more about macular degeneration here.) There are two phases of macular degeneration, called dry AMD and wet AMD.

Wet AMD is the advanced stage of the disease in which new blood vessels begin to grow to try to nourish the sick macula. However, these vessels are weak which causes them to break and leak, causing further visual damage.

For these patients, the best form of treatment is called anti-VEGF injections. VEGF stands for “vascular endothelial growth factor,” which is linked to development of the leaky vessels in wet AMD. Anti-VEGF agents help to slow the disease process and level of damage by preventing the growth of these vessels in the first place. Ophthalmologists will administer these injections as frequently as necessary and will closely follow the patient to monitor for change. (You can learn more about anti-VEGF treatments here.)